scholarly journals Medicolegal Causation Investigation of Bacterial Endocarditis Associated with an Oral Surgery Practice Using the INFERENCE Approach

Author(s):  
Putri Dianita Ika Meilia ◽  
Maurice P. Zeegers ◽  
Herkutanto ◽  
Michael D. Freeman

Investigating causation is a primary goal in forensic/legal medicine, aiming to establish the connection between an unlawful/negligent act and an adverse outcome. In malpractice litigation involving a healthcare-associated infection due to a failure of infection prevention and control practices, the medicolegal causal analysis needs to quantify the individual causal probabilities to meet the evidentiary requirements of the court. In this paper, we present the investigation of the most probable cause of bacterial endocarditis in a patient who underwent an invasive procedure at a dental/oral surgical practice where an outbreak of bacterial endocarditis had already been identified by the state Department of Health. We assessed the probability that the patient’s endocarditis was part of the outbreak versus that it was an unrelated sporadic infection using the INFERENCE (Integration of Forensic Epidemiology and the Rigorous Evaluation of Causation Elements) approach to medicolegal causation analysis. This paper describes the step-by-step application of the INFERENCE approach to demonstrate its utility in quantifying the probability of causation. The use of INFERENCE provides the court with an evidence-based, transparent, and reliable guide to determine liability, causation, and damages.

Author(s):  
Amira Mhuthia Adila ◽  
Nur Ramadhan ◽  
Puspa Nujulla ◽  
Putri Dwi Ardiyanti ◽  
Rina Oktavia ◽  
...  

Infections due to health services or Healthcare-Associated Infection (HAI) or known as nosocomial infections are infections that occur in patients during treatment in hospitals or other health facilities. The prevention and control of nosocomial infections is a worldwide challenge. This study aims to examine the literature, articles, or journals of research results regarding the implementation of prevention and control of nosocomial infections in hospitals. The method used is a literature review with 10 journals that were reviewed and written from 2015 to 2020, or written in the last 6 years with the keywords "Analysis of the Implementation of Nosocomial Infection Prevention and Control". The results obtained are 8 journals that have obstacles such as lack of Human Resources (HR), insufficient funds and infrastructure, there are still many officers who have not taken action according to Standard Operating Procedures (SOP), many officers have not received training, there is no incentive for officers. , there is an unbalanced workload, the reporting system is not maximized, the use of Personal Protective Equipment (PPE) is not optimal, and cough etiquette has not been carried out by officers. So it is necessary to add things that must be met such as training of officers, completing the needs (facilities and infrastructure) for officers, providing sanctions for officers when violating (not taking actions according to SOPs), providing incentives for officers, and even giving rewards for officers who obey comply SOP, especially given strict supervision from the hospital so that officers and patients do not transmit their disease to each other or other people.


2017 ◽  
Vol 26 (2) ◽  
pp. 611-624 ◽  
Author(s):  
Joanna Harris ◽  
Kenneth Walsh ◽  
Susan Dodds

Hospital infection control practices known as Contact Precautions are recommended for the management of people with pathogens such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococci. Background: The patient is isolated, and staff are required to wear gloves, and a gown or apron when providing care. A notice is displayed to remind staff of these requirements and an ‘alert’ message is placed in the patient’s medical record. Objective: The aim of this article is to discuss and explore whether practices used in hospitals to reduce the transmission of endemic antibiotic-resistant organisms are ethically justified in today’s healthcare environment in the developed world. In order to do this, the history of the development of these practices is summarised, and the evidence base for their effectiveness is reviewed. Key bioethics principles are then discussed and contextualised from the perspective of hospital infection prevention and control, and an ethically superior model for the prevention and control of healthcare associated infection is proposed.


2018 ◽  
Vol 20 (1) ◽  
pp. 5-17 ◽  
Author(s):  
Adriana van Buijtene ◽  
Dona Foster

Background: Over 4 million patients acquire a healthcare-associated infection (HCAI) in Europe every year, indicating possible shortcomings in hospitals converting evidence-based infection prevention and control (IPC) strategies into universal adherence. We present a literature review exploring whether insufficient adherence could be culturally based. Aim: To find empirical evidence if and how specific traits of organisational culture improve adherence to IPC strategies utilising HCAI rates as the marker of system failures or successes. Methods: PubMed, CINAHL, PsycINFO and the British Nursing index database were searched from January 2007 to June 2018. Hand-searching, Google Scholar and the snowball effect completed the investigation. The quality of the studies was assessed with the guidance of CASP and Cochrane tools. Results: Twenty papers were eligible for data extraction and thematic analysis. Studies predominantly report positive findings for the association, but none were determined high quality due to multiple methodological concerns. Analysing both quantitative and qualitative research revealed eight major themes: hospital cultures with better HCAI rates foster safety culture; have a generative leadership style; embrace innovation; ensure interventions fit local context; accept long-term orientation; engage and empower health professionals; promote collaboration and communication; and see the benefits of a non-punitive climate. Interpretation: The literature linking organisational culture and HCAI rates is suggestive, but not conclusive, indicating caution about their inferences. Leaving cultural growth to chance or allowing for weak or toxic cultures impedes on our IPC strategies and equivalently our HCAI rates.


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